- Trinity Health (Farmington Hills, MI)
- …root causes of clinical denials . Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, ... Position (Pay Range: $34.9314-$52.3971) Responsible for reviewing all post-billed denials (inclusive of clinical denials )...Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an… more
- St. Mary's Healthcare (Amsterdam, NY)
- …of nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. ... and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers,… more
- Highmark Health (Harrisburg, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... **Preferred** + None **EXPERIENCE** **Required** + 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management **Preferred**… more
- Banner Health (AZ)
- …activities MINIMUM QUALIFICATIONS Completion of an Associate's degree in Nursing. Requires current Registered Nurse ( RN ) license in state worked. Five years ... hours of the Arizona Time Zone. If this opportunity appeals to you, we encourage you to apply today!...of clinical RN experience in prior authorization, utilization review, or case… more
- Carle (Urbana, IL)
- …Location: Carle at The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... clinical documentation review to establish and manage clinical and prior authorization denial appeals for...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- WellSpan Health (York, PA)
- …Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge, Skills, and Abilities: + Advanced ... Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care facilities. +… more
- HCA Healthcare (Nashville, TN)
- …required + Relevant education may substitute experience requirement + Currently licensed as a registered nurse ( RN ) or in the state(s) of practice and/or ... over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you... Nurse Team Lead is responsible for providing clinical input or interpretation for denials that… more
- Genesis Healthcare (Philadelphia, PA)
- …accordance with department policiesPerforms other duties as requested.Qualifications: Registered Nurse .Significant experience in the Healthcare ... that clearly argue for payment of the services provided. Specific reasons for denials are to be addressed directly with justification for the services to be… more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to...systems and other healthcare software. **Licenses and Certifications** + Nursing\ RN - Registered Nurse -… more
- Glens Falls Hospital (Glens Falls, NY)
- …services, including charge discrepancies, CCI edits, and charge review . Serve as a clinical resource for appeals and denials . Review/update of Charge ... Hospital is seeking a strategic, forward thinking, and motivated Registered Nurse with leadership experience to join...this role is for you! *Team Impact* As the Clinical Nurse Manager, you will provide overall… more
- Billings Clinic (Billings, MT)
- …preferred License and Certification Healthcare Provider and ACLS CPR certifications Current Registered Nurse license in the state of Montana Billings Clinic ... and/or continued stay Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials Proactively communicates with… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; Bachelor's Degree in Nursing; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with… more
- Alameda Health System (San Leandro, CA)
- …Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **Additional Information** ... SLH Case Manager RN , Full Time, Benefited, Days, 8hours, 1.0fte +...Case Management, Utilization Review, Home Health or Public Health Registered Nurse experience. Schedule: every other weekend… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and utilization management **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License + AHA Basic Health Care Life Support HCP ... team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient… more
- Ascension Health (Austin, TX)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Alameda Health System (Alameda, CA)
- …health preferred.** **Required Licenses/Certifications:** **Valid license to practice as a Registered Nurse in the State of California.** **Required ... AHD Case Manager RN + Alameda, CA + Alameda Hospital +...action when cases do not meet criteria - coordinates denials with the attending physician, and the UR physician… more
- University of Michigan (Ann Arbor, MI)
- …with providers + Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials ; input into appeals ; share findings with providers + Review all ... RN CASE MANAGER: University Hospital (Care Management) Apply...areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates… more
- Hackensack Meridian Health (Old Bridge, NJ)
- …and/or Google Suite platforms. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License or NJ Licensed Social Worker or NJ ... staff with all care management processes, including LOS, throughput, patient flow and denials and appeals follow up. + Applies process improvement methodologies… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... to ensure accurate, timely, compliant documentation that drives accurate billing Qualifications + Clinical review positions will require a RN degree in nursing… more